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Wednesday, November 28, 2012

Clerkship Preference

In light of my post last week, about people with special considerations (i.e. kids) getting preference for the holidays, I wanted to post this story. A version of this was originally on my personal blog:

During second year of med school, most schools have a lottery to decide on what the third year rotations will be, both the order and where we would have those rotations. There were four main hospitals we rotated through, two of which were nearby and two of which were about an hour and half away.

Prior to our 3rd year clerkship lottery, we voted on special considerations for the clerkship lottery. Basically, students emailed in their special needs, and an email was sent to the class with the anonymous requests and we could vote on them. These were some of the requests I remember:

--A few students who had children asked for all their rotations at one particular hospital so they wouldn't have to move around.

--A couple of students asked for an elective during a certain month so they could get married.

--Two male students asked for an elective month during their wives' due dates

--One student asked for an elective month when his father was having cancer surgery

--One student asked for rotations at a certain location because she only had one car and she carpooled with her husband

Out of our class of 100+ students, 12 anonymously asked for special considerations. Out of the 12, 10 passed through majority class vote. (Notably, the car one didn't pass, the one with kids/births did.) I actually voted yes for all of them, mostly because I felt if they believed it was important enough to get special consideration, they cared about it a lot.

Anyway, the day after we found out which requests passed, one woman in our class sent out the following email:

This is ridiculous! Many of those reasons were absolutely silly. What was the percent of votes needed to pass this anyway? I can't believe the votes passed with those stupid reasons these students gave.

Because for one thing, if your parents are ill, get a visiting nurse, since there is nothing you can do while you are studying anyway. Secondly, all these people that want to take care of their family or assist with their wife's pregnancy or take care of the children or see your children and all that... well, we all have loved ones we would like to see as often as possible, but because we chose such a demanding profession, we simply don't necessarily have that luxury. We just make it work without having to subject our colleagues to it. If it matters so much, have your family member move to where you are or you can commute or hire a baby sitter that can pick your children up from school.

I easily could have said something equally lame, but I sacrificed and let people with more important reasons have their say. But all these crazy reasons, I tell you, is unfair to the class as a whole and it is especially unfair to people that had good reasons but took the initiative to find solutions to their issues.

We generally all thought this particular person was being extremely selfish. What do you think?

22 comments:

Wow have your family members move to you?? I think that you need people making these special demands so the medical profession can become manageable for people who want families or want to help dying relatives. I'm sure there were people who worked In factories with horrible working conditions who didn't believe anyone deserved special treatment. I'm sure the same thing went with the hours of intern year. This woman was probably the car pool lady.

Well, why should she have to be in a less desirable location for her clerkships just because someone made the choice to have children? I mean, they knew what they were getting into when they went to a med school with multiple locations for clerkships and had kids, and now they're asking to inconvenience everyone instead of dealing with a situation that they knew would develop.

My guess is that she had some sort of extenuating circumstances as well, but assumed that she would get denied (and probably given a lecture) if she asked for special consideration. So she didn't. But then other people asked, and not only did NOT get a lecture, they actually got their requests granted. This made her mad. However, rather than suck it up and file away the info for a later date like a mature person would have done, she had a fit about it. Unfortunately, at the entire class.

You can call her crazy, but being a parent comes with distinct responsibilities. One of the major responsibilities of being a parent is having adequate childcare, which includes backup and backup for your backup. If you know you are at a med school where there are rotations a fair distance away, as parents we should be prepared for what comes. This is no surprise. Should we feel sorry for people who didn't take this into account? Certainly not.

my point was just in reference to the hiring a visiting nurse part for ill family members. I realize that this is not identical to childcare issues which are also important. i just wonder if now that she's in practice she has a different view of family/friends being involved in her patients' care. I know that i view an involved family as a huge bonus to the care i provide and the well-being of my patients. I also love visiting nurses and have nothing against them, but in my experience they are not a subsitute for many of the functions family members provide (like taking notes about a complicated medical problem, different diagnostic and treatment options, and needed next steps). all of this is a sidebar. at my med school, the dean's made the schedule, and to my knowledge which is possibly incomplete, all "loved one" related preferences were accomodated whenever possible. None of the people with kids were sent on family medicine rotations out of the immediate area. i'm not sure about the wisdom of having your peers decide, although obviously you could have a dean that played favorites or was in some other way unfair.

*I'm honored.*I stick by what I said in my previous post. CYA when it comes to childcare is important! Additionally, like holidays, clerkships aren't a surprise. Every Medical school I have seen so far is crystal clear regarding where these will take place. As I research schools to apply to, I take these factors into account. In fact, my top school has rotations at another facility nearly 2 hours away. It comes with the territory. If I choose the school, I know what is coming. If I didn't know, that's my problem. I would be fine with voting/lottery for people who wish to remain at a certain facility, but it should NOT be required.

I think this is a nice counterpoint to the blog you wrote last week. Shows that we are a community, and it helps to voice our needs and try to accomodate each other. Sure, everyone deserves their holiday, but if one person has extenuating circumstances and another could care less if they have the holiday off, it helps to be aware of the issues and work it out. That's the kind of discussion we have in my group. Not everyone always gets their way, but we rotate yearly who gets first pick of holidays and try to help each other out once the dust is all settled.

The only one of those requests that I think is ridic is the carpool one. Seriously, buy an effing car. I don't think I should be inconvenienced because you want to save a couple thousand bucks (my last 2 cars cost <2k).

I think the big difference between this and your previous post is that it considered ALL extenuating circumstances. For example, my husband works 65-80 hours a week regularly and we have a small kid. Two women in my program have husbands who are public school teachers. Not the same thing. I don't think they should automatically get higher preference to spend the holidays with their families than people without kids and I do think that's how automatically giving preference to people with kids would wind up shaking out. Not being able to find acceptable childcare is a true extenuating circumstance that can be addressed on a case by case basis IMO while giving blanket preference to parents would likely be abused and would (rightly) lead to resentment.

FWIW, my med school lets you rank either location or order and every year there's someone who ranks order hoping they'll get nearby locations and spams the whole school looking to change their order because they don't want to be away from their spouse/dog/kid or have strict dietary restrictions and have to prepare all meals at home.

Well, why should my classmates get to decide for me that I have lower preference than someone else? What does it matter what someone's reason for wanting a particular month off is? I mean, if I wanted a particular month off so I could lie on the couch in my PJs watching a RHONY marathon, why is that less legit than someone whose spouse is giving birth?

I agree with Gizabeth above: this is a nice counterpoint to your previous post. I might suggest that an important difference is that these requests are for consideration once, and not every year, year after year with different people requesting special consideration and often the same people being asked to give up preferences.

Further, the group voted on special considerations, and decided as a group what mattered. It wasn't imposed by a rigid policy that always discriminates against people without a dependent.

Yes, but I know people who really, really wanted their rotations at a particular site so that they could live with their parents or some similar reason that they knew wouldn't get votes. Those people may have voted against the special considerations but still had to yield. And not just for one day of the year, but for an entire YEAR. Some people were really, really upset by their schedules.

I just feel that people who really need special considerations in ANY work situation should be given it. Frequently that need is small kids, but there are plenty of others reasons.

I've rarely felt that I needed those considerations. But I think there should be a way for people who need it to get it.

wow. I'm curious to know how the rest of med school went for this person- how was she viewed by the rest of the class? Did she have issues collaborating with other students? Aside from being utterly un-empathetic, I'm astounded that she wouldn't be at least embarrassed to send out a screed like that.

Interesting.... many of us are drawn to medicine and are willing, though perhaps begrudgingly, to make sacrifices in terms of time for family or hobbies or "me time" .... but, I don't think you can expect others to make all of the same sacrifices as you and worse you cannot hold them responsible for not being willing to make the same sacrifices without attempts to avoid undesired sacrifices if there is no adverse outcome like to this request than I would say it's that person's own pride for not making her requests not that the other's were invalid.

In the end we measure other women up to our own "mother-ness" I don't think we can measure other's educational plans (taking time off for family stuff, requesting timing or location for a rotation if it doesn't hurt anyone) or professional plans (work full time vs part time vs full service vs narrowing your scope for better hours).

This make me so disheartened. I understand that people don't want to be inconvenienced, but can't we just help each other out without begrudging it so openly? You can't have a sustainable society, let alone a healthy work environment, without a give-and-take. Especially in a field as demanding as medicine, we really need to have a culture of helping each other out both so that everyone can do their job effectively and so that we can maintain lives outside of work, whether we're single or married, parent or childless. I happen to think that situations where other people are relying on the person involved (i.e. a child, a sick parent or spouse, etc) are legitimately more urgent, but there are definitely exceptions. It shouldn't be too much to ask for a work situation where I'll be covered if I have to stay home because my backup childcare falls through and I'll cover a colleague if they have to be with their sick parent, or if they have an important date, or whatever, without resentment!! We're taught in medical school about altruism; why doesn't that apply to our colleagues? I dread bumping into this kind of attitude when I'm a resident...

I think R's suggestion is appealing because it imagines situations where people ask someone for a favor and expect to reciprocate. The set up Fizzy originally had was a policy statement: it should be done like this.

The problem with policy, perhaps, is that most adults have had experiences where policy is used abusively, and without an "out." If it's always policy that people with dependent care needs will always get preference, that will feel abusive to those without dependents. Further, those without dependents may feel that those with dependents will abuse the system. (It doesn't take many people abusing the system for it to feel like an abusive system.)

Bardiac, I agree with you about the first post. I think it would have been received more positively if the recommendation hadn't been presented as policy. I imagine that nearly everyone could get behind the idea of thoughtfully and fairly planning holiday schedules and considering other coworkers' needs. But to say that people with children--other dependents and situations weren't even mentioned in the post--should be given preferential treatment for having holidays off seemed rather extreme to me.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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